Coeliac and IBS

Question 1

What is coeliac disease

Answer 1

T-cell mediated autoimmune inflammatory condition

Question 2

What happens when gluten is eaten

Answer 2

Gluten activates an abnormal response

Leads to production of IPA antibodies and t-cell mediated inflammatory response that targets bowel

Leads to chronic inflammation if eaten long term

Vilous atrophy forms (damage to the lining of the small intestine)

This decreased surface area leads to malabsorption

Question 3

Which bowel mostly affected in coeliac

Answer 3

Small

Question 4

Histology finding in coeliac

Answer 4

Increase in intraepithelial lymphocytes

Vilous atrophy

Crypt hyperplasia

Chronic inflammatory cells (lymphocytes) in lamina propria

Question 5

Peak age of coeliac

Answer 5

50-60

Question 6

What isotopes is coeliac disease associated with

Answer 6

HLA DQ2
HLA DQ8

Question 7

Link between family history and coeliac disease

Answer 7

Those with a first degree relative are more likely to get it

Question 8

Autoimmune causes of coeliac

Answer 8

Increased risk if concurrent autoimmune illness e.g. thyroid disorders and T1DM

Also with Down and Turner syndromes

Question 9

What rash can coeliac disease be associated with

Answer 9

Dermatitis herpetiformis
-Uncommon blistering sub epidermal eruption of skin,
-Often itchy

Question 10

Clinical features of coeliac disease

Answer 10

1/3 asymptomatic
Mouth ulcers
Steatorrhoea
Failure to thrive if child
Diarrhoea
Abdo pain
Bloating
Unexpected weight loss
Malaise and weakness

Question 11

Complications of untreated disease

Answer 11

Malabsorption
Anaemia
Increased of GI malignancy and T-cell lymphoma
Osteoporosis
Hyposplenism (so pt more prone to infections)

Question 12

Investigations in suspected coeliac

Answer 12

Blood test
Serological blood sample
Definitive diagnosis- endoscopy and biopsy of small bowel

Question 13

Which blood tests to do for coeliac

Answer 13

FBC - can find iron deficiency or macrocytic anaemia due to folate deficiency
LFT
U&E
Bone profile
Vitamin D
vitamin b12
Haematinics and albumin to check for nutritional deficiencies

Question 14

What serological blood samples would you take

Answer 14

1st line- total immunoglobulin A (igA) and IgA tissue transglutaminase (tTG)

2nd line- IgA endomysial antibody (EMA) can be used If IgA tTGA is unavailable or in cases where it is weakly positive

Question 15

MANAGMENT of coeliac

Answer 15

Lifelong gluten free diet
-Consultation with dietician is important

Question 16

Which foods always contain gluten

Answer 16

Wheat flour
Barley
Durum
Couscous
Soy sauce
Beer

Question 17

Cause of IBS

Answer 17

Unknown

Question 18

Risk factors of IBS

Answer 18

Stress and other psychological factors
Dietary triggers (alcohol, caffein, spicy foods)
Enteric infection

Question 19

Epidemiology of IBS

Answer 19

More common in women
Mostly affects people aged 20-30

Question 20

Symptoms of IBS

Answer 20

Abdo pain
Bloating
Change in bowel habit

Question 21

When to make a diagnosis of IBS

Answer 21

abdo pain which is either:
-Related to defecation and /or
-Associated with altered stool frequency and/or
-Associated with altered stool form or appearance

and at least two from the following:
-Altered passage of stool (straining, urgency, incomplete evacuation)
-Abdo bloating, distension, hardness
-Symptoms aggravated by eating
-Passage of rectal mucus

Question 22

Conservative management of IBS

Answer 22

Advice on healthy eating and adjusting fibre intake based on symptoms
Avoid dietary triggers like alcohol, spicy and fatty foods
Weight loss
Regular exercise
Stress management
Regular meals and lots of fluid
Low FODMAP diet

Question 23

medical management of IBS

Answer 23

Loperamide for diarrhoea
Antispasmodics for abdo pain/cramping
peppermint oil
Laxatives for constipation